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- Title
Severe Acute Respiratory Syndrome Coronavirus 2 Infection Versus Vaccination in Pregnancy: Implications for Maternal and Infant Immunity.
- Authors
Conti, Maria Giulia; Terreri, Sara; Terrin, Gianluca; Natale, Fabio; Pietrasanta, Carlo; Salvatori, Guglielmo; Brunelli, Roberto; Midulla, Fabio; Papaevangelou, Vassiliki; Carsetti, Rita; Angelidou, Asimenia
- Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with adverse maternal and neonatal outcomes, yet uptake of SARS-CoV-2 vaccines during pregnancy and lactation has been slow. As a result, millions of pregnant and lactating women and their infants remain susceptible to the virus. Methods We measured spike-specific immunoglobulin G (anti-S IgG) and immunoglobulin A (anti-S IgA) in serum and breastmilk (BM) samples from 3 prospective mother-infant cohorts recruited in 2 academic medical centers. The primary aim was to determine the impact of maternal SARS-CoV-2 immunization vs infection and their timing on systemic and mucosal immunity. Results The study included 28 mothers infected with SARS-CoV-2 in late pregnancy (INF), 11 uninfected mothers who received 2 doses of the BNT162b2 vaccine in the latter half of pregnancy (VAX-P), and 12 uninfected mothers who received 2 doses of BNT162b2 during lactation. VAX dyads had significantly higher serum anti-S IgG compared to INF dyads (P < .0001), whereas INF mothers had higher BM:serum anti-S IgA ratios compared to VAX mothers (P = .0001). Median IgG placental transfer ratios were significantly higher in VAX-P compared to INF mothers (P < .0001). There was a significant positive correlation between maternal and neonatal serum anti-S IgG after vaccination (r = 0.68, P = .013), but not infection. Conclusions BNT161b2 vaccination in late pregnancy or lactation enhances systemic immunity through serum anti-S immunoglobulin, while SARS-CoV-2 infection induces mucosal over systemic immunity more efficiently through BM immunoglobulin production. Next-generation vaccines boosting mucosal immunity could provide additional protection to the mother-infant dyad. Future studies should focus on identifying the optimal timing of primary and/or booster maternal vaccination for maximal benefit.
- Subjects
BLOOD serum analysis; MOTHERS; LACTATION; COVID-19; IMMUNIZATION; IMMUNOGLOBULINS; ACADEMIC medical centers; COVID-19 vaccines; BREAST milk; PREGNANT women; IMMUNITY; LONGITUDINAL method; PREGNANCY
- Publication
Clinical Infectious Diseases, 2022, Vol 75, pS37
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciac359